Pediatric Coding Alert

Question: We have a provider who wants to bill based on time, but they only spent 8 minutes with the patient. Can we still bill the evaluation and management (E/M) service with 99212?

AAPC Forum Participant

Answer: Whether you can bill for time using 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.) depends on whether there is sufficient documentation that shows your provider spent additional same-day, non-face-to-face time on this encounter. There are two reasons for this.

First, face-to-face time is not the only time the provider can use to calculate time for E/M visits. The AMA defines time for E/M coding as the total time (based on minutes) the provider spends on the date of service during which a provider personally rendered services related to the patient’s care, even if the times are not consecutive. In other words, the time your provider spent preparing to see the patient, and any time they spent following up after the service that is related to the service, is billable time and should definitely be used when calculating the appropriate level of service (if the documentation supports it).

Second, effective Jan. 1, 2024, CPT^® removed the time ranges from both the new and established office/outpatient E/M code

descriptors and replace them with a single time that “must be met or exceeded.” For an established patient, the total time to be met or exceeded is 10 minutes to report a 99212. This means that if the provider did not document any time spent other than the 8 minutes of face-to-face time, you will need to level the encounter based on medical decision making (MDM). This is because the time spent did not meet or exceed 10 minutes, as is required by the new rules.